eMedicine Specialties > Sports Medicine > Lower Limb

Iliopsoas Tendinitis: Differential Diagnoses & Workup

Author: Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Coauthor(s): Kathleen M Walsh, EdD, ATC, LAT, Director of Sports Medicine and Athletic Training, Assistant Professor, Department of Health Education and Promotion, East Carolina University
Contributor Information and Disclosures

Updated: Aug 7, 2009

Differential Diagnoses

Contusions
Lumbosacral Radiculopathy
Femoral Head Avascular Necrosis
Osteitis Pubis
Femoral Neck Stress Fracture
Slipped Capital Femoral Epiphysis
Groin Injury
Snapping Hip Syndrome
Hip Fracture
Hip Overuse Syndrome
Lumbosacral Disc Injuries

Other Problems to Be Considered

Appendicitis (right groin)
Arthritis
Avulsion of the lesser trochanter
Chondral defect
Gynecologic pathology
Hernia
Intra-articular loose bodies
Labral Tear
Obturator nerve entrapment
Pelvic stress fracture
Synovitis

Workup

Laboratory Studies

  • Laboratory studies rarely are indicated if diagnosis of iliopsoas tendinitis is certain.
  • If the diagnosis is unclear, a CBC count, erythrocyte sedimentation rate or C-reactive protein, rheumatoid factor, anticyclic citrullinated peptide antibody, antinuclear antibody, and urinalysis are helpful ancillary tests for distinguishing among several other causes of groin pain.

Imaging Studies

  • Plain radiographs
    • Hip radiographs often are the initial imaging study obtained because diagnosis of iliopsoas tendinitis may not be demonstrated clearly.
    • A pelvic anteroposterior radiograph and frog leg lateral radiograph of the affected hip often are adequate initial studies.
    • Radiographs typically are normal in cases of iliopsoas tendinitis, but may demonstrate other bony pathology, which may contribute to the patient's symptom complex.
  • Ultrasonography
    • Ultrasonography has been used more frequently as a noninvasive diagnostic adjunct in the diagnosis of muscle-tendon injuries. Demonstration of a thickened tendon is the usual finding.
    • Ultrasonography may demonstrate an excessive amount of fluid in the iliopsoas bursa consistent with iliopsoas bursitis, which may be either a primary or secondary problem.
    • Remember that ultrasonography is highly user-dependent and may not be the optimal test at institutions with personnel who are unfamiliar with ultrasonography use for this type of examination.
  • MRI
    • MRI currently is the criterion standard in the ancillary evaluation of painful conditions of the hip and pelvis, particularly because many anatomical structures may be the origin of the pain. In a recent study of 19 endurance athletes with groin pain and an established clinical diagnosis, MRI was shown to reclassify 32% of the hips to a different etiology for the groin pain. These diagnoses included iliopsoas muscle tears and iliopsoas tendinitis.
    • In evaluating musculotendinous injury, the spin-echo T2-weighted images demonstrate increased signal intensity associated with swelling and inflammation. However, in hemorrhage associated with a more severe musculotendinous injury, both the T1-weighted images and T2-weighted images depict a high-signal intensity.
    • In peritendinitis evaluation, increased fluid in the peritendinous tissue is detected on the spin-echo T2-weighted images or short T1 inversion recovery (STIR) sequence as a focus of high-signal intensity surrounding a normal tendon.
    • On the other hand, tendinosis is demonstrated on the spin-echo T1-weighted images as an area of higher signal intensity within the tendon associated with myxoid degeneration or angiofibroblastic proliferation. The spin-echo T2-weighted images may show an abnormal signal (usually less than that seen on the T1-weighted images) or a normal signal.

Procedures

  • Lidocaine challenge test
    • Lidocaine challenge test may be performed in a challenging case of iliopsoas tendinitis where cause of pain is unclear.
    • Utilizing an anterior approach through the femoral triangle, and under ultrasonographic guidance, an interventional radiologist or orthopedic surgeon attempts to bath the iliopsoas tendon with 1% lidocaine. In general, 10 mL of lidocaine administered via a 25-gauge spinal needle is adequate for local anesthesia.
    • Relief of symptoms after injection confirms diagnosis.

More on Iliopsoas Tendinitis

Overview: Iliopsoas Tendinitis
Differential Diagnoses & Workup: Iliopsoas Tendinitis
Treatment & Medication: Iliopsoas Tendinitis
Follow-up: Iliopsoas Tendinitis
Multimedia: Iliopsoas Tendinitis
References
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References

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Further Reading

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Keywords

iliopsoas tendinitis, iliopsoas bursitis, iliopsoas syndrome, internal snapping hip syndrome, inflammation of the tendon, anterior hip pain, groin pain, rheumatoid arthritis

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Contributor Information and Disclosures

Author

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Coauthor(s)

Kathleen M Walsh, EdD, ATC, LAT, Director of Sports Medicine and Athletic Training, Assistant Professor, Department of Health Education and Promotion, East Carolina University
Disclosure: Nothing to disclose.

Medical Editor

Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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